Clinical Semantics - Computational Intelligence in Healthcare: Advanced Methodologies - page 11

2.2 Transition from a Legacy to a New Computerized Clinical Process
A study presenting the experiences gathered from the migration of an existing and
deployed joint replacement surgery information system from a legacy, 2-tier architec-
ture to a new, 4-tier architecture is presented in [2]. The key functionalities of the
system are [2]
- structured data entry and aggregate reporting of prosthetic components installed in
hip, knee, ankle, shoulder, elbow and wrist joint replacement surgeries. This includes
the trade names, types, serial numbers and physical dimensions of the installed com-
ponents. In addition, details on the operation, such as immediate complications, are
also recorded. The data entry is carried by the operating orthopedic hospitals. Aggre-
gate information on the installed components is transferred annually to the National
Agency for Medicines for quality assurance and reporting purposes. This functionality
replaces manual, paper-based reporting on installed prosthetic components.
- an automated call-up system for alerting post-operative follow-up sites on forthcoming
new follow-ups. This functionality removes the reliance on a manual call-up list and
enhances information transfer between operative and post-operative follow-up sites.
Fig. 3. Legacy architecture of the joint replacement surgery management system [2]
Figures 3 and 4 present the legacy and new architectures of the system. The legacy
system based is on a standard 2-tier, fat client architecture while the new system uses
a 4-tier, thin client architecture. The benefits of modern multi-tier architectures in
health care information system design are well-established. These include reusability,
flexibility, reductions in initial system development cost and effort, and, more contro-
versially, provision of an easy, open migration pathway for future change of technol-
ogy and system redevelopment [16].
The study includes discussion on the motivation for the migration and on the tech-
nical benefits of the chosen technical migration path and an evaluation of user experi-
ences. The results from the analysis of clinical end-user and administrator experiences
show an increase in the perceived performance and maintainability of the system and
a high level of acceptance for the new system version. [2].
Still - the study concludes [2] - despite the success of this architectural migration
project, such endeavors often represent one of the major challenges in clinical infor-
matics. The migration process of highly structured information systems does need